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Annals of Surgical Oncology

, Volume 20, Issue 7, pp 2256–2260 | Cite as

Parathyroid Cryopreservation after Parathyroidectomy: A Worthwhile Practice?

  • Kevin Shepet
  • Amal Alhefdhi
  • Reid Usedom
  • Rebecca Sippel
  • Herbert Chen
Endocrine Tumors

Abstract

Background

Parathyroid cryopreservation is often utilized for patients having parathyroidectomy. This allows for future autotransplantation if a patient becomes permanently hypocalcemic after surgery. However, the practice of cryopreservation is costly and time-consuming, while the success rate of delayed autotransplantation is highly variable. We sought to determine the rate and outcomes of parathyroid cryopreservation and delayed autotransplantation at our institution to further evaluate its utility.

Methods

At our institution, 2,083 parathyroidectomies for hyperparathyroidism (HPT) were performed from 2001 to 2010. Of these, parathyroid cryopreservation was utilized in 442 patients (21 %). Patient demographics, preoperative diagnoses, and other characteristics were analyzed, as well as the rate and success of delayed autotransplantation.

Results

Of the 442 patients with cryopreservation, the mean age was 55 ± 1 years and 313 (70.8 %) were female. A total of 308 (70 %) had primary HPT, 46 (10 %) had secondary HPT, and 88 (20 %) had tertiary HPT. Delayed autotransplantation of cryopreserved parathyroid tissue was used in 4 (1 %) patients at an average time of 9 ± 4 months after initial surgery. Three of the 4 patients remained hypoparathyroid after this procedure. The single cured patient underwent the procedure only 4 days after the initial parathyroidectomy.

Conclusions

Although cryopreservation was used in over one-fifth of patients undergoing parathyroidectomy, the need for parathyroid reimplantation was very low (1 %). Furthermore, the success rate of parathyroid autotransplantation was poor in these patients. Therefore, the continued practice of parathyroid cryopreservation is questionable.

Keywords

Parathyroid Gland Parathyroid Tissue Permanent Hypoparathyroidism Total Parathyroidectomy Invasive Parathyroidectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

Supported in part by University of Wisconsin Department of Surgery NIH T32 Training Grant (5 T32 DC 9401-2) and an American Cancer Society MEN2 Thyroid Cancer Professorship.

Disclosure

The authors declare no conflict of interest.

References

  1. 1.
    Pitt S, Panneerselvan R, Chen H, et al. Secondary and tertiary hyperparathyroidism: the utility of ioPTH monitoring. World J Surg. 2010;34:1343–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Ito F, Sippel R, Lederman J, et al. The utility of intraoperative bilateral internal jugular venous sampling with rapid parathyroid hormone test. Ann Surg. 2007;245:959–63.PubMedCrossRefGoogle Scholar
  3. 3.
    Shoback D. Clinical practice. Hypoparathyroidism. N Engl J Med. 2008;359:391–403.PubMedCrossRefGoogle Scholar
  4. 4.
    Guerrero MA. Cryopreservation of parathyroid glands. Int J Endocrinol. 2010;2010:829540.PubMedGoogle Scholar
  5. 5.
    Wagner PK, Seesko HG, Rothmund M. Replantation of cryopreserved human parathyroid tissue. World J Surg. 1991;15:751–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Cohen MS, Dilley WG, Wells SA Jr, et al. Long-term functionality of cryopreserved parathyroid autografts: a 13-year prospective analysis. Surgery. 2005;138:1033–40.PubMedCrossRefGoogle Scholar
  7. 7.
    Wells SA Jr, Gunnells JC, Shelburne JD. Transplantation of the parathyroid glands in man: clinical indications and results. Surgery. 1975;78:34–44.PubMedGoogle Scholar
  8. 8.
    Wells SA Jr, Christiansen C. The transplanted parathyroid gland: evaluation of cryopreservation and other environmental factors which affect its function. Surgery. 1974;75:49–55.PubMedGoogle Scholar
  9. 9.
    Brennan MF, Brown EM, Sears HF, Aurbach GD. Human parathyroid cryopreservation: in vitro testing of function by parathyroid hormone release. Ann Surg. 1978;187:87–90.PubMedCrossRefGoogle Scholar
  10. 10.
    McHenry CR, Stenger DB, Calandro NK. The effect of cryopreservation on parathyroid cell viability and function. Am J Surg. 1997;174:481–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Saxe A. Parathyroid transplantation: a review. Surgery. 1984;95:507–26.PubMedGoogle Scholar
  12. 12.
    Borot S, Lapierre V, Carnaille B, Goudet P, Penfornis A. Results of cryopreserved parathyroid autografts: a retrospective multicenter study. Surgery. 2010;147:529–35.PubMedCrossRefGoogle Scholar
  13. 13.
    Caccitolo JA, Farley DR, van Heerden JA, Grant CS, Thompson GB, Sterioff S. The current role of parathyroid cryopreservation and autotransplantation in parathyroid surgery: an institutional experience. Surgery. 1997;122:1062–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Wells SA Jr, Farndon JR, Dale JK, Leight GS, Dilley WG. Long-term evaluation of patients with primary parathyroid hyperplasia managed by total parathyroidectomy and heterotopic autotransplantation. Ann Surg. 1980;192:451–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Saxe AW, Spiegel AM, Marx SJ, Brennan MF. Deferred parathyroid autografts with cryopreserved tissue after reoperative parathyroid surgery. Arch Surg. 1982;117:538–43.PubMedCrossRefGoogle Scholar
  16. 16.
    Herrera M, Grant C, van Heerden JA, Fitzpatrick LA. Parathyroid autotransplantation. Arch Surg. 1992;127:825–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Feldman AL, Sharaf RN, Skarulis MC, et al. Results of heterotopic parathyroid autotransplantation: a 13-year experience. Surgery. 1999;126:1042–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Saxe AW, Spiegel AM, Marx SJ, Brennan MF. Deferred parathyroid autografts with cryopreserved tissue after reoperative parathyroid surgery. Arch Surg. 1982;117:538–43.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Kevin Shepet
    • 1
  • Amal Alhefdhi
    • 1
  • Reid Usedom
    • 1
  • Rebecca Sippel
    • 1
  • Herbert Chen
    • 1
  1. 1.Section of Endocrine Surgery, Department of SurgeryUniversity of WisconsinMadisonUSA

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